How to Pay for PrEP: Insurance and Financial Assistance Options

Under the Affordable Care Act, pre-exposure prophylaxis (PrEP) is available at no cost for patients under almost all health insurance plans, including the cost of medications, office visits, and required lab tests. According to the American Sexual Health Association, options for accessing these HIV prevention medications also exist for uninsured individuals through drug manufacturer assistance and state-funded programs.

PrEP Coverage for Insured Patients

Most health insurance plans must provide PrEP at no cost due to the Affordable Care Act. This coverage extends to the clinical visits and laboratory testing necessary to maintain a prescription, the American Sexual Health Association reports.

Patients with plans from the healthcare.gov marketplace can verify their specific coverage through that portal. Those with private insurance or employer-provided plans are advised to check directly with their provider to confirm which specific types of PrEP are covered without cost.

Public insurance options also provide paths to coverage. Medicare Part B covers PrEP medication and related services for eligible participants. Medicaid coverage varies by state, though most states offer PrEP through their basic health plans, according to the American Sexual Health Association.

Manufacturer Assistance and Co-Pay Programs

Pharmaceutical companies provide financial assistance for patients who have commercial insurance but still face high out-of-pocket costs. These programs are generally unavailable to those using Medicare, Medicaid, the Federal Employees Health Benefits Program, or VA/TRICARE.

For Yetzugo, the program provides up to $8,000 in assistance, which includes up to $100 per visit for injection administration, according to Gilead.

ViiV Healthcare operates the ViiV Injectables Savings Program, which assists with deductibles and co-pays for the injectable PrEP option, Apretude. This program is limited to patients with commercial health insurance.

Access for Uninsured Patients

Individuals without health insurance can access PrEP through several federal and private channels, often contingent on income requirements. The Health Resources and Services Administration (HRSA) funds community health centers that offer care regardless of a patient’s ability to pay, using sliding scale fees for lab tests and visits.

Drug manufacturers provide medications free of charge to eligible uninsured patients through specific programs:

• Gilead Medication Assistance Program (MAP): Provides oral medications (Descovy and Truvada) and the injectable Yetzugo at no cost for those who qualify.
• ViiV Healthcare Patient Assistance Program (PAP): Offers Apretude at no cost to eligible patients.

The American Sexual Health Association recommends the PrEP locator tool to find providers who specifically prescribe to patients without insurance. Some of these clinics employ PrEP navigators to help patients with insurance enrollment and financial assistance applications.

State and Local Financial Support

Several U.S. states and municipalities maintain dedicated programs to cover the costs of PrEP medications, office visits, and labs. According to the American Sexual Health Association, these resources are available in:

• California, Colorado, and Montana
• District of Columbia and New York
• Ohio and Oklahoma (both of which provide PrEP navigators)
• Virginia (where navigators are available at most Virginia Department of Health partner sites)
• Massachusetts and Indiana (Indiana provides PrEP navigators)
• Maryland (specifically Howard County, which also offers telehealth)
• Philadelphia, Pennsylvania (where navigators assist uninsured patients)

Additionally, the Patient Advocate Foundation offers the TotalAssist Program, a charitable grant system that provides financial assistance to qualifying patients.